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A 14-year-old client on the eating disorders unit refuses to eat her meals and says to the nurse on the unit, 'You can't make me eat! There is nothing wrong with me.' The nurse will assess this as use of which defense mechanism?
- A. Repression.
- B. Rationalization.
- C. Sublimation.
- D. Denial.
Correct Answer: D
Rationale: The correct answer is D: Denial. Denial is a defense mechanism where an individual refuses to acknowledge reality to avoid discomfort. In this scenario, the client is denying the seriousness of their situation by refusing to eat and claiming there is nothing wrong. Repression (A) involves unconsciously blocking out unpleasant thoughts or feelings. Rationalization (B) is creating logical explanations to justify behavior. Sublimation (C) is redirecting negative impulses into positive behaviors. In this case, denial is the most fitting defense mechanism as the client is refusing to accept the reality of their eating disorder.
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The head nurse on a unit that serves persons with cognitive impairment is concerned about her staff, many of whom seem to be becoming 'burned out' by their challenging work. Which response by the head nurse is most likely to minimize staff frustration and burnout on the unit? Select all that apply.
- A. Educate staff regarding realistic expectations for this patient population.
- B. Arrange for 12-hour shifts so that staff can have more days off per week.
- C. Guide staff to use small, realistic goals as their measure of patient progress.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A because educating staff about realistic expectations for working with persons with cognitive impairment can help them understand the challenges they may face and develop appropriate coping strategies. This knowledge can reduce frustration and burnout by promoting a better understanding of the patients' needs and behaviors.
Choice B, arranging for 12-hour shifts, may actually increase staff burnout as longer shifts can be physically and mentally taxing. Choice C, guiding staff to use small, realistic goals, while helpful in patient care, may not directly address staff burnout. Therefore, the most effective approach to minimize staff frustration and burnout in this scenario is education on realistic expectations.
In Massachusetts, which year contained the highest level of days exceeding the 8-hour average ground-level ozone standard?
- A. 1983
- B. 1984
- C. 2007
- D. 1999
Correct Answer: A
Rationale: 1983 likely had higher ozone exceedances due to less stringent regulations and higher industrial emissions at that time.
What is an appropriate goal for a nurse when working with a patient who has anorexia nervosa?
- A. The patient will achieve rapid weight gain and improve self-esteem.
- B. The patient will restore nutritional balance through safe weight gain.
- C. The patient will accept their body image without therapeutic intervention.
- D. The patient will maintain a healthy weight without any professional assistance.
Correct Answer: B
Rationale: The correct answer is B because restoring nutritional balance through safe weight gain is a realistic and appropriate goal for a nurse working with a patient with anorexia nervosa. This goal focuses on the patient's physical health and addresses the underlying issue of malnutrition. Rapid weight gain (A) may be dangerous and unsustainable. Accepting body image without intervention (C) ignores the severity of the disorder. Maintaining a healthy weight without professional assistance (D) is unlikely for someone with anorexia nervosa who requires specialized care.
Appropriate teaching for a patient with bulimia nervosa who binges and purges is:
- A. Not to skip meals or restrict food.
- B. To eat a small meal after purging.
- C. To eat a large breakfast but no lunch.
- D. None of the above.
Correct Answer: A
Rationale: Step-by-step rationale:
1. A: Not skipping meals or restricting food promotes regular eating patterns, helps stabilize blood sugar levels, and reduces the urge to binge.
2. B: Eating a small meal after purging could reinforce the binge-purge cycle and is not a healthy approach.
3. C: Eating a large breakfast but skipping lunch can lead to imbalanced eating habits and is not recommended for treating bulimia nervosa.
4. D: None of the above options provide a comprehensive and effective approach to managing bulimia nervosa symptoms.
An advance directive gives legally binding direction for health care interventions when a patient
- A. has a new diagnosis of cancer.
- B. is diagnosed with Parkinson's disease.
- C. is unable to make decisions for self because of illness.
- D. diagnosed with amyotrophic lateral sclerosis is unable to speak.
Correct Answer: C
Rationale: The correct answer is C because an advance directive is a legal document that specifies a person's wishes for healthcare decisions if they are unable to make decisions for themselves due to illness. This ensures their preferences are followed. Choices A and B are specific diagnoses and do not address decision-making capacity. Choice D focuses on the inability to speak, which is just one aspect of decision-making ability, but not comprehensive enough for an advance directive.